Minister Dzulkefly’s Achievements (And What They Really Mean)

Drug price controls, Peka B40, compulsory vaccination, electronic medical records, and the smoking ban.

KUALA LUMPUR, May 2 — Health Minister Dzulkefly Ahmad has listed various achievements in his first year in office after Pakatan Harapan (PH) won the historic 2018 election.

These are some of the accomplishments the Amanah leader shared with the press in conjunction with the May 9 anniversary of PH’s first year in office.

He listed 18 “achievements” or “new initiatives”. CodeBlue will pick the five most prominent ones and analyse them.

Cabinet Approves Drug Price Controls

Dzulkefly announced that the Cabinet has approved medicine price controls that will be imposed through a regulation under the Price Control and Anti-Profiteering Act 2011.

He told reporters that the Health Ministry would use external reference pricing to benchmark against cheaper drug prices in other countries. Price ceilings will then be set accordingly at the wholesale and retail points, be it at clinics, hospitals, or pharmacies.

“The objective of medicine price controls is to ensure access to medicine at an appropriate price for the people, as well as to encourage innovation and healthy competition for industry growth,” he said.

Pharmaceutical companies and pharmacists have previously protested against the government’s plan to regulate drug prices, contending that it could inadvertently make medicines more expensive instead.

It is questionable if price controls will really lead to cheaper drugs, as it can push health care providers to use the ceiling price for a product it could have sold for cheaper. Price controls could also have unintended consequences on other stages of the supply chain and on small clinics and pharmacies.

A 2018 study by researchers from the Health Ministry’s Pharmaceutical Services Division and from Universiti Kebangsaan Malaysia found that drug price markups were typically higher in private hospitals, where treatment is usually borne by insurance companies, than in community pharmacies that charge competitive prices to attract individual customers. The study found price markups from wholesale to retail of between 24 per cent and 402 per cent in the private sector from 2011 to 2015 for both generic and innovative medicines; the former has higher markups.

If the government’s aim is to make health care more affordable and to foster competitive prices, it can start with getting private hospitals to display a price list of their standard procedures so that patients can compare. This should be easy enough given that major private hospitals like KPJ, Pantai, and Gleneagles are owned by government-linked corporations (GLCs). Expensive medical bills in private hospitals are not just due to medicine prices, but a whole list of other items.

The cost of care in private hospitals, not simply drug prices, merits greater scrutiny and transparency as a whole.    

Peka B40 ‘Game Changer’

The Peka B40 health screening programme for the bottom 40 per cent (B40) aged 50 and above was started on April 15, aiming to benefit 800,000 people with a RM100 million fund for its pilot phase.

The main objective is to fight non-communicable diseases (NCDs) like diabetes, high blood pressure, and high cholesterol.

Besides providing health screening at registered private clinics, Peka B40 also provides aid to purchase medical devices, incentives to complete cancer treatment, and transport aid to get treated at hospitals. The health screening comprises a physical exam, a breast exam for women and prostate exam for men, a mental test, and blood and urine tests.  

According to Dzulkefly, 2,443 people have been screened on their first visit as of April 29.

“Peka B40 is not just a manifesto promise, but truly a game changer in handling NCDs,” the Amanah minister declared.

However, it is unclear what exactly Dzulkefly’s key performance indicators (KPIs) are to measure the success of Peka B40. How many diabetes, high blood pressure, and high cholesterol cases does the Health Ministry plan to curb through Peka B40 by what year? How many out of 800,000 people does Dzulkefly plan to screen? What about the targeted uptake for the second visit if test results are abnormal?

Nor is it clear how the Health Ministry will pull the B40 to get screened at private clinics, since they can already get free mammograms and pap smears at government hospitals and clinics.

Socso has provided free health screenings, including blood and urine tests, mammograms, and pap smears, for workers since 2013, but over two million vouchers have reportedly not been used.

So what will Peka B40 do differently? How will the Health Ministry follow up with each person to ensure they get treated if they have abnormal test results, or to ensure they continue regular screenings years on if their health is fine?

Task Force To Propose Compulsory Vaccination

The special task force’s proposal to mandate vaccines will be tabled to the Health Ministry’s planning steering committee on May 8 for approval, before it will be tabled to the Cabinet.

Measles fell by almost 37 per cent in the first quarter of the year compared to the same period in 2018.

The Health Ministry, however, should not rest on its laurels, given that some of the states that saw a rise in measles last year were in the most developed states — Kuala Lumpur, Selangor, and Putrajaya — before they fell this year due to increased vaccination activities by the ministry.   

This means that rich and educated people are resisting measles vaccines, who have the ability to spread misinformation about them.

It is unknown if Dzulkefly can push through compulsory vaccination, given that his Cabinet colleagues Dr Wan Azizah Wan Ismail (Women, Family and Community Development) and Maszlee Malik (Education) seem less than thrilled about it.

All Government Hospitals to Use Electronic Medical Records (EMR)

The Health Ministry targets to implement the EMR system in all 145 government hospitals and 1,700 health clinics within three to five years.

Dzulkefly said a quarter of government hospitals and nine to 10 clinics currently had EMR.

“It will enable medical practitioners, including doctors and nurses, to identify and share information on patients’ medical consultations and prescriptions through an integrated system.”

A shared database containing patients’ medical records could ensure continuity of care, but proper data protection procedures must first be drawn up before the system is expanded.

Even the UK with its culture of privacy was forced to cancel its national database of medical records, as it was revealed that patient data could be sold to pharmaceutical and insurance companies.

Smoking Ban Is Lit

Even though Dzulkefly did not list the smoking ban at restaurants as an achievement, CodeBlue believes that it is his top accomplishment in his first year in office. The results speak for themselves.

According to the minister, 580 smokers registered for the Health Ministry’s mQuit stop smoking service from January till April this year, up from an average of 428 people for the whole of last year.

A study also showed that 60 per cent of restaurants did not see anyone lighting up at all since the smoking ban was implemented in January. This is an impressive achievement and shows that continuous public education goes a long way in changing behaviour.

“I also look at a situation of an economy that has not really recovered yet. I would want to see all these feel-good factors coming in first before I impose anything punitive,” said Dzulkefly, when asked why enforcement of the smoking ban was postponed to next year.

Dzulkefly is right in postponing enforcement of the ban.

Smokers must be given enough resources to help them quit smoking. Long-term behavioural change, especially with a tough habit like smoking, does not come from legislation alone.    

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